One goal of a technology-based health care system that fully integrates the technical and social aspects of patient care and therapy is to connect the client with care providers irrespective of separation distance or location of the participants. While clinicians will continue to treat patients in accordance with accepted medical practice, developments in communications technology are making it ever more possible to provide medical services in a time- and place-independent manner.
Past methods of clinical services are generally limited to in-hospital operations. For example, if a physician needs to review the performance parameters of an implantable device in a patient, the patient normally has to go to the clinic. Further, if the medical conditions of a patient with an implantable device warrant continuous monitoring or adjustment of the device, the patient would have to stay in a hospital indefinitely. Such a continued treatment plan poses both economic and social problems. Under the exemplary scenario, as the segment of the population with implanted medical devices increases many more hospitals/clinics and service personnel will be needed to provide in-hospital service for the patients, thus escalating the cost of healthcare. Additionally the patients will be unduly restricted and inconvenienced by the need to either stay in the hospital or make very frequent visits to a clinic.
Yet another condition of the past practice requires that a patient visit a clinical center for occasional retrieval of data from the implanted device to assess the operations of the device and gather patient history for both clinical and research purposes. Such data is acquired by having the patient in a hospital/clinic to download the stored data from the implantable medical device. Depending on the frequency of data collection, this procedure may pose difficulty and inconvenience for patients who live in rural areas or have limited mobility. Similarly, in the event a need arises to upgrade the software of an implantable medical device, the patient will be required to come into the clinic or hospital to have the upgrade installed.
A number of proposals have been made to enable remote programming and monitoring of an IMD from a centralized patient management center. Such systems generally rely on an in-home remote monitor having bidirectional communication with the implanted device for retrieving data from the IMD. The in-home remote monitor (IRM) is coupled to a data communication network to enable transfer of retrieved data to a centralized database or medical support network. Depending on the communication schemes used, patient intervention may be required to accomplish a data transfer between the IMD and the IRM and/or between the IRM and the centralized patient management system.
With the use of long-range telemetry systems, patient intervention may not be required to initiate retrieval of data from the IMD although transmission from the IMD to the IRM may only be accomplished when the patient is within the communication range of the IRM. Thus a patient is required to remain compliant and cooperative in performing remote monitoring or programming sessions using an IRM, which can pose inconvenience and burden to the patient. Furthermore, if a patient is incapacitated due to a clinical event, the patient may be unable to initiate a remote monitoring session. A patient having a serious or life-threatening clinical event at home may be unable to contact help or send an IMD data transmission. There remains a need, therefore, for seamless and passive data transfer from a remote IMD to a centralized patient management system.